Eight patients--six who had a bicondylar fracture of the tibia and two
who had a complex fracture-dislocation--were treated by open reduction and
internal fixation that was achieved through an anterior approach to the
knee. The approach included elevation of the tibial tubercle, proximal
retraction of the extensor mechanism (patellar tendon, retropatellar fat
pad, and patella), and transection and detachment of the anterior horn of
one or both menisci. The extent of the approach depended on the specific
need for exposure. The quality of reduction was better and the rate of
complications was lower, compared with conventional approaches. The main
advantage of this approach is that the tibial plateau and the intercondylar
notch are exposed clearly and completely; this is a prerequisite for the
rapid reconstruction of the joint surface and, in some patients, for the
reattachment or primary suture of the cruciate ligaments. I recommend the
anterior approach with osteotomy of the tibial tubercle in the treatment of
patients who have a severe displaced bicondylar fracture of the proximal
end of the tibia.